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JUDGES SKEPTICAL OF LATEST ACA CHALLENGE — Yesterday, a panel of three Democrat-appointed appeals judges appeared skeptical of a lawsuit alleging the ACA is unconstitutional because of the way it was crafted in the Senate. The case has sort of flown under the radar, but these are the nuts and bolts: The bill that became Obamacare first passed the House, but then the Senate hollowed it out and replaced it with the health law’s completely unrelated language — a move the Pacific Legal Foundation argued was unconstitutional. But the Senate routinely amends bills from the House, and the judges raised sharp questions about whether courts should weigh in on whether a Senate amendment was relevant to the underlying bill. http://politico.pro/1mGH6wl

Happy Friday, PULSE readers. Not gonna lie — I’m pretty stoked about my weekend plans. Now that I’ve finally unpacked the last box, there might actually be time for some fix-it projects around the new place. Send your favorite home improvement links to pcunningham@politico.com. You can throw in some story tips while you’re at it. Have a wonderful weekend, everyone.

“Run to the hills. Run for your Pulse.”

VA SECRETARY ORDERS CLINICS AUDIT — Veterans Affairs Secretary Eric Shinseki, who is being subpoenaed by a House committee that voted to do so yesterday, has ordered an audit at all VA clinics, CNN reports. He’s been under fire for deadly delays in health care at some of his agency’s hospitals. The subpoena will cover emails that allegedly discussed the destruction of a secret list of veterans waiting for care at a Phoenix VA hospital. Shinseki is also expected to testify next week before the Senate Committee on Veterans’ Affairs. The CNN story: http://cnn.it/RuAGlt

SEIU SUPPORTS BURWELL — The union’s president, Mary Kay Henry, called Sylvia Mathews Burwell “uniquely qualified” to champion affordable care as HHS secretary and urged lawmakers against politicizing her confirmation. “We urge Congress not to sully Burwell’s nomination with political attacks that could hurt real people if they succeed in the long run,” she said in a statement. ICYMI, the Pro story on Burwell’s HELP confirmation hearing yesterday: http://politico.pro/1jkHAF4

ENROLLMENT SURVEY — An April survey of exchange enrollees by McKinsey & Company finds that 26 percent of respondents reported being previously uninsured, 87 percent indicated they’d paid their first premium and about 90 percent of those who said the plans might be unaffordable for them qualified for subsidies. Of those who said they’re still uninsured, 23 percent indicated they intend to purchase coverage in 2015 and nearly half of those not intending to enroll next year weren’t aware of the penalty for lacking coverage. The survey results: http://bit.ly/1fT1VBp

CAVANAUGH TO CHAMBER — CMS Deputy Administrator Sean Cavanaugh heads to the U.S. Chamber of Commerce this morning to discuss ways businesses are working to improve the health of their workers. It’s the second in a four-part series of events hosted by the chamber to highlight private sector efforts to develop disease management and care coordination initiatives and discuss barriers that continue to hinder success. CVS vice president Tobias Barker and other executives are also on the agenda. The agenda: http://politico.pro/1jFHXtg

CONTRACEPTION BEFORE THE COURT — The same appeals panel that considered the Obamacare challenge yesterday also heard arguments regarding the contraception mandate brought by Priests for Life. The central question: Can simply requiring someone to sign a form encroach upon religious freedom? That’s what religious nonprofits must do to get out of providing contraception coverage, but they say it still involves them in the provision of coverage for birth control. ICYMI: http://politico.pro/RvI2Fl

BEYOND THE ACA LAUNCH — Two health care scholars write in the New England Journal of Medicine about the Affordable Care Act going forward. Henry Aaron of Brookings writes that even though the law is here to stay, amendments are certain and some desirable changes may become feasible if ACA supporters prevail in 2016. One fix, for example, could be to what’s popularly known as the “family glitch.” http://bit.ly/1nlXUbl

--Joseph Antos of the American Enterprise Institute writes about changes the ACA needs to rein in costs and give people more choices. His suggestions include a defined-contribution approach, meaningful reforms to Medicare and Medicaid and well-funded high risk pools. http://bit.ly/RvJyaC

THIS WEEK’S LYRICS:

Monday: “Teeth in the Grass” by Iron & Wine

Tuesday: “Stormy Weather” by Etta James

Wednesday: “Sweet Child O’ Mine” by Guns N’ Roses

Thursday: “Demons” by Imagine Dragons

Friday: “Run to the Hills” by Iron Maiden

REPEAL THE HIT — Insurers and businesses talk about repealing the ACA’s health insurance tax just about every chance they get. The Stop the HIT Coalition, a group of small business owners, has launched an online “invoice” tool allowing business owners and employees to estimate the cost of the tax for them and send that number to their member of Congress in the form of a mock invoice. The tool: http://bit.ly/1lqWf0D

** Prices for many generic drugs are skyrocketing by 1,000% or more virtually overnight. But Medicare drug plan middlemen may wait months to update reimbursement. Independent community pharmacists can’t sustain losses of $100 or more per prescription. Learn more at www.ncpanet.org/pharmacyaccess **

REPORT: EXPAND “FREE” PREVENTIVE SERVICES OFFERINGS — A new white paper argues that if high deductible plans started covering a broader range of preventive services without cost sharing, the premiums would be a bit higher but they would likely catch on, have better health outcomes and save money over time.

--The paper, by some well-known academics including Michael Chernew, Stephen Parente and Mark Fendrick, models the likely effect on premiums and consumer uptake of high deductible plans if they were to cover services like insulin, eye and foot exams and glucose monitoring supplies for diabetics. The IRS doesn’t currently allow first dollar coverage of treatments for existing conditions like diabetes and other chronic health threats. The white paper: http://bit.ly/1kQ8uSS

GOVERNORS PROBE PFIZER — Maryland Gov. Martin O’Malley and Delaware Gov. Jack Markell wrote to Pfizer yesterday to express concern about the pharmaceutical company’s effort to acquire British rival AstraZeneca. They’re worried about losing jobs in their states due to Pfizer’s history of shuttering research facilities in the U.S. after closing on other corporate transactions. They also raised questions about the tax-driven nature of the bid, as the company would shift its tax home in the process of its proposed takeover of AstraZeneca.

WHAT WE’RE READING

The national health care discussion will soon shift from expanding coverage to costs, which are rising more sharply again, the Kaiser Family Foundation’s Drew Altman writes in the Wall Street Journal. http://on.wsj.com/RuU3uP

Companies have developed all sorts of smart products from phones to watches and now they’re developing smart toothbrushes, the New York Times reports. http://nyti.ms/Rt7AmV

The Tennessean reports hospital CEOs are predicting that more states will expand Medicaid. http://tnne.ws/1ouENcA

USA Today writes that companies are making Obamacare a new scapegoat for disappointments during their first-quarter earnings season. http://usat.ly/1ob7kGM

California’s SHOP exchange has enrolled only a fraction of eligible companies due to glitches, delays and customer service problems, Kaiser Health News reports. http://bit.ly/Rtkwcp

A new study finds that antibiotic-resistant genes are widespread in nature, the Washington Post reports. http://wapo.st/1qkzdhr

The Wall Street Journal writes that NIH scientists say they’ve successfully attacked a woman’s cancer by using her immune system to hone in on genetic mutations unique to her tumors. http://on.wsj.com/1gebcim

** Patients need reliable access to community pharmacies, which need fair reimbursement to stay in business. Costs are surging for scores of generic drugs but pharmacy benefit managers (PBMs) may wait months to update payments to pharmacies. Losses of $40 to $100 or more per prescription are untenable for independent community pharmacies and jeopardize patient access. Generic reimbursement rates should be updated regularly to reflect market costs and should be disclosed to community pharmacies. Support the bipartisan H.R. 4437 to do just that. Learn more at www.ncpanet.org/pharmacyaccess **